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Assisted patency with primary stent placement in distal anastomotic stenoses of lower limb bypass grafts

PURPOSE

To evaluate the feasibility and effectiveness of primary stent placement for treating distal anastomotic infragenicular bypass stenoses in terms of technical success and middle-term (2-year) patency rates.

MATERIALS AND METHODS

Twenty-one patients underwent primary stent placement for the treatment of distal anastomotic stenoses after infragenicular bypasses. Patients underwent clinical and color flow and duplex Doppler ultrasonographic (US) examinations 1, 3, 6, and 12 months after the endovascular procedure and every year thereafter if no complications occurred. Angiography was performed in patients with positive findings at the clinical and US examinations to evaluate the need for repeat endovascular and/or surgical treatment. The mean follow-up was 18.3 months (range, 2-30 months).

RESULTS

Twenty-two clinically significant (>50%) distal anastomotic stenoses were detected in 22 infragenicular grafts created in the 21 patients. The median time between endovascular treatment and surgery was 7.5 months (range, 3-18 months). The mean stenosis length was 1.4 cm (range, 0.8-2.4 cm). Twenty-four stents were implanted, two of which were used to treat restenosis immediately below the previously implanted stent. The technical success rate was 100%. No complications occurred during any of the treatments, and no periprocedural major events or complications were registered. At follow-up, the cumulative primary, primary assisted, and secondary patency rates for the treated graft stenoses were 95%, 95%, and 100%, respectively, at 6 months; 71%, 81%, and 86% at 1 year; and 71%, 76%, and 81% at 2 years. The limb salvage rate was 88%.

CONCLUSIONS

Although this study was limited to a small number of patients, stent placement seems to be a feasible and effective tool in the endovascular treatment of distal anastomotic infragenicular bypass graft stenoses.

Hybrid Therapy in Patients with Complex Peripheral Multifocal Steno-obstructive Vascular Disease: Two-Year Results

PURPOSE

To report the 2-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral multifocal steno-obstructive vascular disease.

METHODS

From September 2001 through April 2003, 47 combined surgical-endovascular procedures were performed in a single session in 44 patients with peripheral occlusive artery disease. Although the common femoral artery is usually treated with open surgery, endoluminal procedures were performed upward in 23 patients (group A), distally in 18 patients (group B), and both upward and downward of the area treated with open surgery in 3 patients (group C). Patients underwent clinical assessment and color duplex ultrasonography examination at 1, 3, 6, 12, 18, and 24 months after the procedure.

RESULTS

The technical success rate was 100%. Two patients died, at 2 and 19 months after treatment, respectively, both from myocardial infarction. Primary and primary-assisted patency rates were 86.2% and 90.8% at 6 months and 79.1% and 86.1% at 24 months, respectively. Thirty-three patients remained free of symptoms, without any secondary interventions, which corresponded to a primary patency rate of 78.6% (33 of 42).

CONCLUSION

Combined therapy simplifies and allows the one-step treatment of patients with complex peripheral multifocal steno-obstructive vascular disease that has indications for revascularization, and it provides excellent long-term patency rates.